1. JAMIA MILLIA ISLAMIA
PHYSIOTHERAPY IN CARDIOPULMNARY CONDITIONS
(BPT 402)
OXYGEN THERAPY
Submitted to: Dr. Jamal Moiz
Submitted by: Shikha Sharma
BPT 4th YEAR
Roll No. 17BPT034
CPRS
2. OXYGEN THERAPY
It is the administration of oxygen at concentration greater than
ambient air.
It is provided as an intent of treatment or preventing the
symptoms and manifestation of hypoxia.
INDICATIONS:
Documented hypoxemia (PaO2= <60, SaO2= <90%)
Severe trauma
Acute myocardial infarction
Acute situation of hypoxemia(high altitude)
Chronic respiratory disease(COPD)
Stroke patient
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3. OXYGEN DELIVERY DEVICES:
Devices which are used to administer, regulate and supplement
oxygen to increase the arterial oxygenation of the patient.
GOAL: Is to match the performance characteristics of the
equipment to both the purpose and patient’s special needs.
DEVICE SELECTION:
3 P’s: Purpose, Patient, Performance.
Purpose: To improve the arterial hypoxemia.
Patient factors:-
o Severity and cause of hypoxemia
o Patient age group(infant, child, adult)
o Degree of consciousness, alertness
o Mouth breathing vs. nose breathing
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4. Low flow oxygen devices High flow oxygen devices
•Can’t deliver constant FiO2; varies
with tidal volume.
•Maintain constant FiO2.
•Deliver oxygen at low flow rate. •Deliver oxygen at very high flow.
•Mixture of O2 and ambient air. •Flow usually 4 times than that of
actual minute volume.
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6. LOW FLOW OXYGEN DEVICES:
NASAL CANNULA: It consists of 2 soft prongs; further attached to
oxygen supply tubing.
Flow rate: 2-4 L/min
It delivers an FiO2 of 0.28-0.36 respectively.
Nasopharynx acts as a reservoir.
It varies in sizes and prong shapes:
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7. ADVANTAGES DISADVANTAGES
•Ideal for long term oxygen therapy. •Can’t provide high flow oxygen.
•Light weight and comfortable. •It causes irritation and can’t be used
in nasal obstruction.
•Patient is able to speak, eat and drink. •FiO2 varies according to the
respiratory efforts.
•Humidification not required. •High flow rates are uncomfortable.
•Affordable(low cost)
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8. NASAL CATHETER: It is lodges into the anterior naris by a foam collar,
inserted to just above the uvula.
Flow rate: 2-3 L/min.
FiO2: 35-40%
Contraindication: When nasal mucosal tear is suspected.
ADVANTAGES:
No advantage over nasal cannula.
DISADVANTAGES:
Deep insertion can cause air swallowing and gastric distension.
It requires repositioning in every 8 hrs to prevent breakdown.
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9. SIMPLE FACE MASK: It consists of oxygen inlet and exhalational ports.
FiO2 highly varies and unpredictable.
Rebreathing of carbon dioxide: If flow rate < 2L/min or if minute
ventilation is too high.
Normal respiratory pattern: If flow rate 4L/min and FiO2 0.34-0.4
If flow rate > 8L/min; no increase in FiO2.
ADVANTAGES:
Can be used in mouth
breathers.
DISADVANTAGES:
Uncomfortable
Require tight seal.
Interferes with ADLs.
High chance of
rebreathing.
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10. PARTIAL REBREATHING MASK:
FiO2: 0.6-0.8
Reservoir bag capacity is 1L.
To exhale CO2 and refill O2 reservoir; flow rate ≥8L/min.
Flow rate should be sufficient to keep bag 1/3-1/2 inflated at all
times.
ADVANTAGES:
Inspired gas do not mix with room air.
If oxygen supply is interrupted; patient can breath room air through
exhalation ports.
DISADVANTAGES:
More oxygen flow doesn’t increase FiO2.
Interfere with eating and drinking.
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11. NON REBREATHING MASK: It consists of one way valve between
mask and bag.
FiO2: 95%
Flow rate: 10-15L/min.
INDICATIONS:
Head injury: Rebreathing of CO2 would be detrimental.
ADVANTAGES:
Highest possible FiO2 without intubation.
Spontaneously breathing patients with severe hypoxia.
DISADVANTAGES:
Uncomfortable, requires tight seal.
Interfere with eating, drinking.
It is not suitable for long term use.
Malfunction can cause CO2 build up and suffocation.
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12. HIGH FLOW OXYGEN DEVICES:
VENTURI MASK(AEM- Air Entrainment Mask):
• Size of the constriction determines the final concentration of oxygen for
the given gas flow.
• Due to high fresh gas flow rate, the exhaled gases are rushed from the
mask via its holes.
• FiO2 varies from 0.24-0.6.
ADVANTAGES:
• Fine control of FiO2 at fixed flow.
• Precise FiO2.
• Can be used for low FiO2.
DISADVANTAGES:
• Uncomfortable
• Interfere with drinking and eating.
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13. HIGH FLOW NASAL CANNULA:
Flow rate: 8L/min(infants), 40L/min(children).
ADVANTAGES:
Respiratory distress failure
High flow washes out CO2 in anatomical dead space.
Creates positive nasopharyngeal pressure.
FiO2 remains constant.
Gas is warmed to 37℃ and completely humidified , mucociliary
function remains good; little discomfort due to this.
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14. BLENDING SYSTEM: It is ideal for spontaneously breathing patients
requiring high FiO2.
Flow rate: >60L/min.
FiO2: 24-100%
Inlet: Separate pressurized air,
oxygen source.
(Gases are mixed either manually
Or with blender)
Output: Mixture of air and O2
with precise FiO2 and
flow.
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15. TRACHEOSTOMY COLLAR/MASK: It is inserted into trachea.
Flow rate: 8-10L/min.
It provides accurate FiO2 and good humidity.
INDICATION:
Requirement for chronic oxygen therapy.
ADVANTAGES:
Comfortable
More efficient
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16. T-PIECE: It is used at the end of endotracheal tube while weaning from
ventilator.
It provides accurate FiO2.
It provides good humidity.
OTHER DEVICES:-
Oxygen hood
Oxygen tents
AMBU bag
(Artificial Manual Breathing Unit): It is a hand held device.
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17. HAZARDS AND COMPLICATIONS OF OXYGEN
THERAPY
1. Oxygen toxicity: It is more evident in infants especially prematurely
delivered.
• Within few hours of breathing FiO2: 100% - Airway irritation, ciliary
dysfunction and decrease in mucus clearance.
• Common symptoms:
o Sore throat
o Burning
o Cough
o Chest pain(inspiration)
o Dyspnea
2. Absorption atelectasis: Administration of high concentration of
oxygen(FiO2 >70%) washes out nitrogen from lungs.
3. Oxygen induces hypoventilation: COPD patients
4. Fire hazards 17
18. REFERENCES
EGAN’S Fundamental of Respiratory Care, Edition 11,
Robert M. Kacmarek, James K. Stoller, Albert J. Heuer.
Clinical Application of Mechanical Ventilation, Edition
4, David W.Chang, Ed.D., RRT-NPS.
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